surgical attire. Surgical attire should cover the arms to prevent skin squames from infiltrating the sterile field including when opening sterile packages and performing procedures such as skin antisepsis. Cloth surgical hats may be worn throughout a shift but should be covered by a bouffant cap when entering restricted areas. Finally, scrub attire should not be worn outside of the hospital.18 Skin prep solutions that use chlorhexidine de-


crease pathogens on the skin for a longer time than povidone-iodine solutions. Chlorhexidine has been shown to be effective for up to 18 hours postadmin- istration, which allows more time for the incision to heal before being exposed to external microbes.19 Another important factor in skin prep is to train staff to one specific method of applying the antisepsis before surgery and to continue education through auditing so that staff do not become complacent. Once the newborn has been delivered, every effort


should be made to allow the mother to hold her newborn in the same manner as she would have if she had a vaginal birth. Skin-to-skin contact has many proven benefits; however, some hospitals are hesitant to create a policy that supports this in the OR. Several studies have disproved many of the con- cerns regarding thermal regulation of the newborn and skin-to-skin contact. By placing the newborn directly on the mother’s chest and covering both with a warmed blanket, hypothermia can be avoided. OR temperatures can be increased to support the family dyad. Most important, staff can be trained to assess a newborn while on the mother’s chest, to adjust the equipment in the OR to make room for the infant and staff member, and to promote breastfeeding in the first hour of life.20


Postsurgical care Women who have undergone a C-section, whether elective, urgent or emergent, will have different chal- lenges than a woman who gave birth vaginally. The patient’s ability to care for herself and her newborn may be affected depending on her level of pain and mobility. If the cesarean section was not elective, the patient may be having feelings of disappointment or distress regarding her birth experience that can interfere with bonding. Adequate pain management after surgery is espe-


cially important in the postpartum patient. Because of the high fluid shift, postpartum patients are at a much greater risk for developing deep vein thrombosis and pneumonia. Early ambulation significantly reduces that risk, but patients who are experiencing pain may not want to walk. Developing an individualized pain program will help the patient be more comfortable, which will allow her to be better able to meet the needs of her newborn, including the ability to breastfeed and hold her baby. Pain status should be evaluated


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Amy Jones, a gravida 2, para 1, arrived to the labor deck 36 hours ago in active labor. Her last delivery was a cesarean section for breech presentation. She discussed with her provider her desire to attempt a vaginal birth after cesarean section and is aware of all the associated risks. She is 39 weeks and 4 days gestation, and had hoped to labor without pain medication. She labored for 12 hours without any cervical change, and low-dose oxytocin was initiated 10 hours ago. She is currently 4-cm dilated, 50% effaced with a -1 station and a suspected occipital posterior fetal lie. She has been at this stage for more than six hours with no change despite an increase in the oxytocin. Her provider has recommended a C-section based on fetal weight and failure to progress in la- bor. Amy becomes tearful during the conversation and states to her nurse that she felt like a failure because she was not able to deliver her baby like everyone else. After additional counseling by both provider and nurse on the safety of the surgery, Amy consented to a C-section. To reduce the risk of infection, she received prophylactic antibiotics prior to first incision and was prepped in accordance to the hospital’s surgical site infection prevention policy. Her baby was born at 7:42 p.m., weighing 9 pounds and 14 ounces. Amy was able to put the baby skin-to-skin in the OR. For the first 12 hours following surgery and prior to ambulation, Amy was allowed to keep the baby in her room due to the support of her partner. She was discharged three days later following an uneventful recovery period in which she received family-centered care that supported the bonding with her newborn.


1. The greatest risk factor for a repeat C-section include: a. Prior C-section


c. Full-term gestation


b. History of cervical procedure d. Maternal fatigue


2. Prophylactic antibiotics should be administered within: a. One hour prior to incision c. Two hours postincision


b. Two hours prior to incision d. 24 hours postincision


3. How can skin-to-skin contact between mother and newborn be achieved in the OR?


a. It’s not possible to achieve skin-to-skin contact due to the temperature in the OR and the effects of anesthesia.


b. Skin-to-skin contact cannot be done in the OR, but the infant can be swaddled in blankets and placed on the mother’s chest.


c. The baby can be placed directly on the mother’s chest without any additional measures for temperature stability.


d. The baby can be placed skin-to-skin with the mother and then covered with warmed blankets.


4. After the cesarean delivery, the infant should be:


a. Taken to the newborn nursery for monitoring until the mother is able to ambulate


b. Allowed to stay with the mother for the first few minutes following deliv- ery, then taken to the newborn nursery until the mother is out of recovery


c. Encouraged to stay with the mother throughout the recovery period with support from the nursing staff and family to ensure the mother and baby are safe


d. Placed in the bed with the mother if there are not other family members present to help care for the infant


Answers


1. A — Women who have undergone a prior C-section have a 90% chance of having another.


2. A — Antibiotics should be administered one hour prior to incision to decrease the risk of postsurgical infection.


3. D — To promote breastfeeding, bonding and stable temperature in the newborn, the infant should be placed directly on the mother’s chest and covered in warmed blankets.


4. C — Promoting family-centered care allows the infant to remain with the mother throughout the recovery period and minimizes interruptions to the bonding period.


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